金水六君煎加味联合沙美特罗替卡松粉吸入剂对慢性持续期老年哮喘患者血清VEGF,TGF-β1的影响

Effect of Modified Jinshui Liujunjian Combined with Salmeterol/Fluticasone on VEGF and TGF-β1 in Serum of Senile Asthma on Persistent Stage

目的:探讨金水六君煎加味联合沙美特罗替卡松粉吸入剂治疗慢性持续期老年哮喘患者的临床疗效及对血清血管内皮生长因子(vascular endothelial growth factor,VEGF),转化生长因子-β1(transforming growth factor-β1,TGF-β1)的影响。方法:选取符合纳入标准的老年哮喘患者100例,随机数字表法分为对照组和治疗组。每组各50例。两组均根据病情给予氧疗、化痰、抗感染等措施,并给予沙美特罗替卡松粉吸入剂50μg·(500μg)^-1,1吸/次,2次/d。同时,对照组加用茶碱缓释胶囊0. 1 g,bid,治疗组加用金水六君煎加味治疗。两组疗程均为8周。观察两组患者的中医证候疗效,治疗前后、治疗后3,6个月两组患者的哮喘控制测试(asthma control test,ACT)得分,治疗前后两组患者的肺功能及血清VEGF,TGF-β1水平。评价两组治疗期间的用药安全性。结果:治疗组的总有效率高于对照组(P <0. 05)。与对照组比较,治疗后、治疗后3,6个月治疗组ACT得分均明显升高(P <0. 05)。治疗后与对照组比较,治疗组的呼气流量峰值(peak expiratory flow,PEF)变异率和血清VEGF,TGF-β1水平均明显降低(P <0. 05);1 s用力呼气量占预计值百分比(percentage of forced expiratory volume in first second and its predicted value,FEV1%),第1秒末用力呼气量占用力肺活量百分比(percentage of forced expiratory volume in first second and forced vital capacity,FEV1/FVC)均明显升高(P <0. 05)。治疗期间两组不良反应发生率比较,治疗组明显低于对照组(P <0. 05)。结论:与茶碱缓释胶囊联合沙美特罗替卡松粉吸入剂治疗比较,金水六君煎加味联合沙美特罗替卡松粉吸入剂治疗慢性持续期老年哮喘可更明显地提高患者的临床疗效,改善肺功能,其作用机制可能与调节血清VEGF及TGF-β1水平有关。

Objective: To explore the clinical efficacy of modified Jinshui Liujunjian combined with salmeterol /fluticasone on senile asthma on persistent stage and its effect on vascular endothelial growth factor ( VEGF) and transforming growth factor-β1 ( TGF-β1 ) in serum. Method: The 100 cases of senile asthma who met inclusion criteria were selected and divided into two equal groups by random number table: the control group and the treatment group. Patients of the two groups were given oxygen therapy,phlegm reduction,infection control and salmeterol /fluticasone 50 μg·( 500 μg)^- 1 . Patients in control group were given sustained release capsule of theophylline in addition to the above therapy,while patients in treatment group were given modified Jinshui Liujunjian. The course of treatment was 8 weeks. The therapeutic effectiveness of traditional Chinese medicine ( TCM) syndrome between two groups was observed. Asthma control test ( ACT) scores at four different time points ( before and after treatment,3,6 months after treatment),pulmonary function,the levels of VEGF and TGF-β1 in serum before and after treatment between two groups were also observed. The pharmic safety during treatment was evaluated. Result: The total effective rate of treatment group was significantly higher than that of control group ( P < 0.05). Compared with that in control group,ACT scores in treatment group were significantly higher at three different time points ( after treatment,3 and 6 months after treatment)( P < 0.05). Compared with that in control group,peak expiratory flow ( PEF) variability and the levels of VEGF and TGF-β1 in serum in treatment group were significantly lowered after treatment ( P < 0.05),while the percentage of forced expiratory volume in the first second and its predicted value ( FEV1%),and the percentage of forced expiratory volume in the first second and its forced vital capacity ( FEV1 /FVC) were significantly higher ( P < 0.05). Compared with that in control group, the incidence of the untoward effect in treatment group were significantly lowered during treatment ( P < 0.05). Conclusion: Modified Jinshui Liujunjian combined with Salmeterol /Fluticasone was more effective than Sustained release capsule of theophylline combined with Salmeterol /Fluticasone in improving the clinical efficacy and pulmonary function of senile asthma on the persistent stage. Its mechanism of action is probable correlated with the reduction of levels of VEGF and TGF-β1 in serum.